DESCRIPTION: Recent research has shown that glucose control relates directly to lower morbidity (e.g. retinopathy, nephropathy, neuropathy) for diabetics, suggesting that it is extremely important for diabetic patients to adhere to medical regimens that result in normalization of blood sugar. These Diabetes Control and Complications Trial (DCCT) findings emerged from a study in which patients were preselected as being likely to adhere, but it raises the critical question of what factors promote adherence for all patients. The proposed work integrates research from the literatures on Self Determination Theory, patient activation, patient empowerment and motivational interviewing to formulate a model of patient self-regulation and to derive hypotheses about enhancing glucose control. Previous work suggests that activating patients leads to improved HbA1c so the proposed research explores the mediating processes through which this occurs. The proposal hypothesizes that patients' autonomous self regulation mediates this effect. If confirmed, this hypothesized mediation will point to other factors in the health care climate that could influence patient adherence. Two studies in a Diabetes Center are proposed. The first is an observational study and the second is an evaluation of a patient intervention. The studies employ data from questionnaires, ratings of audiotaped provider-patient interactions, glucometers, medical records, and medical tests (HbA1c) to test the investigator's model of the relations among the health care climate, patients' motivation, patients' behavior and health outcomes. This work could be of considerable significance for developing potentially cost-effective strategies for health care practitioners to use in enhancing patient motivation and adherence and thus reducing the long term health consequences of diabetes.